Claim Entry

Fields marked are Mandatory

Freight Bill Number
Sail Date
Vessel and Voyage
Container Number
CLAIMANT INFORMATION
Company Name
Name of Person Filling Claim
Address
City
State
Zip Code
Email
Phone
Fax
STATEMENT OF CLAIM
DETAILS

Explain in detail how you determined the claim amount. List the number and description of the goods, the nature and extent of loss or damage, the invoice cost, and the amount of your claim. You must have at least one Description and Claim Amount.

Description  Claim Amount 
$
$
$
$
$
Total Amount Of Claim: $
Comments
SUPPORTING DOCUMENTS

Correspondence supporting a claim such as: shipper’s invoice, repair invoice (if applicable), proof of delivery, inspection, etc., must be faxed to 310.537.1400 or mailed to 19201 Susana Rd, Rancho Dominguez, CA 90221, Attention: Claims Department. Without supporting documents we are unable to begin process of a claim and will be unable to consider your claim for payment.

Important! Original Vendor Invoice is REQUIRED, all other document(s) are optional.

Original Vendor Invoice
Copy of Bill of Lading
Copy of Paid Freight Bill
Other
Consignee Copy of Delivery Receipt (Proof of Delivery)
Inspection Report, select type of report:
Original Repair Invoice

WHEN FOR ANY REASON, THE ORIGINAL PAID FREIGHT BILL OR BILL OF LADING IS NOT PROVIDED, CLAIMANT MUST INDEMNIFY CARRIER OR CARRIERS AGAINST DUPLICATE CLAIMS SUPPORTED BY ORIGINAL DOCUMENTS

INDEMNITY AGREEMENT
When the original bill of lading and/or freight bill is not submitted, or is not available for submission, but copies of the original are submitted in support of the claim described above, the claimant agrees to indemnify and hold harmless the carrier receiving this claim, named above, and any participating carriers, and will pay to the carrier or any participating carrier all losses, costs, damages, counsel fees or any other expenses it (the carrier) may incur resulting from all lawful subsequent duplicate claims arising out of the same shipment which may be filed and supported by the original documents.

Foregoing statement of fact is hereby certified as correct.

*Claimant Signature
Date